CAUSES OF HALOPERIDOL DISCONTINUATION IN PATIENTS WITH TOURETTES DISORDER - MANAGEMENT AND ALTERNATIVES

Background: Neuroleptics are considered the mainstay of treatment in T ourette's disorder, and haloperidol is deemed the treatment of choice by many. Factors such as treatment efficacy and the side effects that appear in response to neuroleptic administration have been implicated in affecting medication compliance. However, a detailed evaluation of these factors has yet to be undertaken in Tourette's disorder. Method: Of 51 consecutive referrals to a Tourette's disorder clinic, 48 met D SM-III-R criteria for Tourette's disorder. Of these 48, 28 had previou sly received neuroleptics. In this set of 28 patients, 24 (16 male, 8 female) had initially received treatment with haloperidol, and they ma de up the present sample; their ages ranged from 10.4 to 47.9 years (m ean = 27.1), and age at onset ranged from 2 to 16 years. Each patient completed an evaluation consisting of a Tourette Syndrome Questionnair e and a clinical interview with the patient and involved family member s. Charts were also reviewed to gather information concerning side eff ects and other factors that led to haloperidol discontinuation and/or noncompliance. Results: Duration of treatment ranged from 3 days to 14 years (mean = 3.6 years). In this sample, 12.5% (3/24) of the subject s continued medication without interruption (mean +/- SD = 8.4 +/- 5.1 years of medication). Of the 21 patients who discontinued haloperidol , 66.7% (14/21) did so because they experienced intolerable side effec ts, 9.5% (2/21) because the medication became ineffective, 9.5% (2/21) because of the fear of experiencing certain side effects, and 14.3% ( 3/21) because of a combination of these factors. The principal side ef fects that led to discontinuation included dysphoric reactions, akathi sia, nervousness, sedation, dystonic reactions, and cognitive dulling/ feeling drugged. Conclusion: Careful monitoring of side effects and ef ficacy is essential to continued compliance with haloperidol. In addit ion, psychoeducation about potential consequences of medication admini stration may help promote compliance in those patients who develop fea rs of possible adverse reactions.